Male Reproductive In Class Activity Flashcards
More information on urinary patterns
Examples include urinary frequency and urgency, difficulty starting a stream of urine, reduced force and size of the urinary stream, sensation of incomplete bladder emptying, straining to begin urination, post-void dribbling or leaking (common if sig retention), and presence of blood in the urine.
The patient’s pattern of awakening during the night to urinate has increased significantly since his last visit.
The risk for BPH and prostate cancer risk increases with age, with nightly urination being a key indicator.
Color urine
Odor - infection
Med history
How much urine - little bit each time may mean retention
Strain to void
Stream weak
When started
UTI?
What further assessment data should the nurse collect regarding Mr. Bahr’s statement about awakening more frequently to urinate?
Exam men over 50 have annually to eval possible enlargement prostate
Not diagnose prostate cancer - tells if prostate enlarge - if enlarged - prostate around urethra and as enlarges compressed urethra so have all urinary symptoms
transurethral/transrectal (preferred) - punch through rectal wall and get specimen
DRE - digital rectal exam
As age increases
See trend - seeing increases in PSA - monitor overtime if cont see increase overtime; BPH increases and infection can as well
Measures the amount of prostate-specific antigen - Protein produced by cells in the prostate
If a prostate is enlarged then PSA levels can be elevated
A PSA test is often ordered as standard of care even in the absence of an enlarged prostate.
Higher levels of PSA can be associated with the presence of prostate cancer
Serum acid phosphatase levels and early prostate cancer antigen can also be elevated in prostate cancer - specific to prostate cancer
What is the purpose of a PSA blood test? Why would this test be ordered?
It can also be elevated with advancing age and with BPH (benign prostatic hypertrophy), prostate cancer, age
Screening not diagnostic
Early diagnosis allows for quick intervention and treatment that can be life-saving.
Increased with BPH, age, cancer - screening; not diagnostic - Something wrong with prostate
Gen to prostate
Higher levels of PSA can be associated with the presence of prostate cancer
Medications:
2 diff classes - blocks testosterone: prostate shrinks to help with urinary symp; relaxes smooth muscle and allows for easier stream around urethra
Blocks testosterone: Side effects: erectile dysfunction, decreased libido, dizziness due to orthostatic hypotension, more fatigue, increased breast tissue - blocking testosterone; takes awhile
Relaxes smooth muscle: Assess for orthostatic hypotension, tachycardia, syncope; vasodilating and relax; works quickly
What are treatment options for BPH?
Surgery:
Most common is TURP (transurethral resection of prostate)
TURP - into urethra; pretty traumatic; remove sections of the prostate; can be brutal; cutaway some prostate tissue that is compressing on urethra
Most common
Postoperative care for TURP
Catheter in place after surgery
Will feel the urge to void continuously
Stay in place for awhile
Foley and flushing it - clear bladder and urethra all time - reason is because stuck large catheter - trauma and bleeding and if bleeding stays there and not flushing that can clot; purpose continuous bladder irrigations (CBIs) can bleed little bit but want prevent clot - cause retention and serious issues - clear bladder and urethra; typ 24 hrs but sometimes longer
3 way catheter - urinary catheter; 2 L bags of saline into bladder and drains into foley catheter - feel like have void all time because constantly filling bladder; filling them and empty catheter; goes into bladder and drains out
Monitor for infection - Risk for infection - messing with catheter all time
Prevent complications of immobility
Assess pain and VS q 2-4 hours
Maintain the rate of the continuous bladder irrigation (CBI) to ensure clear urine without clots and bleeding
Normal saline used and need 3 way urinary catheter
Assess color, consistency, and amount of urine output - Imp monitor output - goal: light pink: not bright red or large clots because those obstruct - sometimes tissue and bits clot in beginning but not large - those obstruct; want keep flow going so preventing clots because extremely painful; adjust based on color
Normal for the urine to be pink after surgery
Check the drainage tube frequently for external obstructions (kinks) and internal obstructions (blood clots, decreased output); Check for kinks - make sure flowing right - so much in bladder so really uncomfy really fast
After catheter is removed, may experience burning on urination, urinary frequency, dribbling, little leakage since catheters large; want good urinary func before d/c
Symptoms are normal and will decrease
May also pass small clots and tissue debris for several days; Bright red urine - report after catheter removed
Increase fluid intake
At least 2000 to 2500 mL daily - keep kidneys flowing
Will decrease dysuria and keeps the urine clear
See what flow is and adjust based on right color; clear - slow down flow; red - up flow; initially see pink but want get to clear/bright yellow
If medications are not successful what is the most common treatment for BPH?
In the early postoperative period after transurethral resection of the prostate (TURP), Mr. Bahr will be at risk for hemorrhage. The prostate gland is highly vascular, and bleeding can be excessive.
Prostate extremely vascular and so very high risk bleeding; want baseline H&H and want check clotting factors
Why were these labs done? RBC, platelet count, H&H, PT, aPTT
Evaluate kidney function
When kidney function is impaired, BUN and creatinine are elevated
Backflow of urine from the bladder to the kidney can cause kidney impairment
Kidney func - severe BPH and lot symp - can have lot urinary retention and can lead to kidney injury; severe urinary retention over long period can damage kidneys
Why were these labs done? - BUN and serum creatinine
Not want straining -
increases bleeding
When assessing Mr. Bahr’s urine in the immediate postoperative period, what characteristics would you anticipate?
A. clear and amber
B. pink
C. cloudy and yellow
D. brown with sediment
Answer: B
Hemorrhage is a possible complication of transurethral resection of the prostate (TURP). If hemorrhage occurred, shock could develop. Which signs of shock might be assessed if hemorrhage occurred? (Select all that apply)
A. Decreased blood pressure
B. Increased heart rate
C. Lower abdominal pain
D. Pallor
E. Elevated temperature
F. Restlessness
Answer: A, B, D, F
Decreased blood volume, vasoconstriction; HR increases to compensate for lower BP
Typ no increase in temp
Mr. Bahr complains of severe “cramping and tightness” in his abdomen. Which actions should the nurse implement? (Select all that apply)
A. Apply gentle massage over the lower abdomen
B. Have him lie in the fetal position
C. Encourage him to use relaxation techniques he learned preoperatively
D. Notify the HCP immediately
E. Check the urinary drainage tube for kinks and clots
F. Check the HCP’s prescription to see if medication is prescribed for relief of spasms
Answer: C, E, F
Not an emergency - not need HCP
s/s of some bladder spasms/cramping - not uncommon post-TURP to have probs with that; first thing do is check urinary drainage for kinks and clots
Mr. Bahr’s urinary catheter has been removed. Plans are made for discharge if he is able to void. How would you assess for urinary retention (Select all that apply)?
A. Inspect for edema of the penis
B. Inspect the suprapubic area for distention
C. Palpate the suprapubic area for distention
D. Percuss the suprapubic area for tympany
Answer: B, C
Retention would be dullness
A teaching plan is developed for Mr. Bahr immediate needs after discharge. Which needs should be included in the plan? (Select all that apply)
A. Need for high fluid intake
B. Use of enemas as needed
C. Regular walking
D. Immediate resumption of aerobic exercise
E. Perineal exercises
F. Immediate resumption of sexual activity
G. Need to avoid heavy lifting
Answer: A, C, E, G
High fluid intake - unless contraindicated
Do want prevent constipation, bearing down, lot straining; enemas is extreme just do stool softener
Issues with incontinence; strengthening perineal muscles
Avoid heavy lifting postop - prevent bleeding
Mr. Bahr needs instructions about the signs and symptoms of complications of the TURP that should be reported to the HCP. What signs and symptoms should be reported?
A. Urine dribbling
B. Gross hematuria
C. Pale urine
D. Cloudy urine after intercourse
Answer: B
Gross - large amount
Large amount of bleeding
Some dribbling if had continuous bladder irrigation - if over long period time and other signs of retention then report
Pale urine - fine
Cloudy urine - semen retrograde into urethra and when pee have cloudy urine
